Distal phalanx (finger) fracture

Revision as of 21:39, 24 March 2020 by Od1 (talk | contribs) (Management)

Background

  • Fracture of distal portion of distal phalanx is also known as a "Tuft fracture"
  • Hand: finger slammed in door
  • Foot: stubbed toe or dropped a heavy object

Clinical Features

  • Pain and/or swelling of the digit
  • Sensation usually intact
    • Pain on palpation

Differential Diagnosis

Distal Finger (Including Nail) Injury

Hand and Finger Fractures

Examination

  • Evaluate for tendon damage
  • Always look for a second fracture

Imaging

  • Hand Xrays to rule out additional fractures
  • Comminuted tuft fracture
    Tuft's fracture
    • Stable
  • Longitudinal fracture
    • Usually non-displaced and stable
  • Transverse fracture
    • Evaluate for angulation/displacement
  • Intraarticular fracture

Management

General Fracture Management

Acute pain management Open fractures (excluding distal phalanx fractures) require immediate IV antibiotics and urgent surgical washout Neurovascular compromise from fracture requires emergent reduction and/or orthopedic intervention

Specific Management

  • Nonoperative
    • Nondisplaced: Splint with the DIP joint in extension (splint should extend past the tip of the distal phalanx
      • Most cases
    • Eval nail bed
    • Digital blocks can be helpful for evaluation and management
    • Do not attempt to reduce comminuted tuft fracture
  • Call Hand or Ortho (institution dependent) for complex finger injuries

Prophylactic Antibiotics

Controversial but in general, prophylactic antibiotics are indicated for grossly contaminated open wounds, and can be considered in high risk patients (ex. diabetics, peripheral artery disease). Otherwise, NOT indicated in open distal phalanx fracture (aka tuft fracture)

  • Fracture is at distal phalanx (i.e. tuft fracture)
  • Intact digital arteries
  • Clean wound

Disposition

  • Refer for:
    • Tendon dysfunction
    • Nerve dysfunction
    • Displacement or angulation
    • Intraarticular fracture
    • Complex involving Nailbed laceration

See Also

References